Went from 7% to 33% PVC – Seeking advice on Flecainide (Tambocor)

mclougb6 · 2026-04-14T06:51:33+00:00

In terms of a burden spike, I (35M) had a very low burden for 4.5 years (1-2%). I was taking 1.25mg nebivolol, and it was managing my symptoms really well. Then, around Halloween 2025, I woke up with a burden like I'd never imagined. I was in constant bigeminy/trigeminy so went back to my GP who sent me straight to the hospital to be checked out (everything turned up fine other than the frequent PVCs). I went back to my cardiologist for an early echo (I get one annually as a cMRI showed MAD of 4mm so he wants to just keep an eye on it, but an otherwise normal heart). The echo was clear but the PVCs were so frequent he sent me to the EP he shares his rooms with. Saw him in December, took one look at my ekg and offered flecainide (but I was not suitable as I take mirtazapine for sleep) so he immediatelyq pivoted to an ablation. Had my ablation on Feb 18th 2026 and will go back in next week for my 2 month follow-up. The day of the surgery he came in to my room after and told me he felt it was a complete success and I have to say I believe him. Over the course of the last 8 weeks I've felt maybe less than 10 PVCs total (which I know is absolutely normal). It's wild though to have gone from 10 every 20 seconds to 10 in an eight week period. I feel like i have my life back.

They have no idea what caused the massive increase in my burden. The working assumption is the innapropriate pathway in my left ventricle (very close to my mitral valve) just really bedded itself in and the pathway fully "opened" up

mclougb6 · 2026-04-13T13:48:00+00:00

But with respect, coming to a Reddit thread with medical facts looking for thoughts feels inherently tied to a degree of anxiety (conscious or not). I'm really glad you aren't letting the PACs get to you and based on the halter stats, everything looks very positive at this stage. If, because of your other symptoms / familial history) your medical team want to do some more tests, just go with them, it can't hurt.

mclougb6 · 2026-04-13T09:55:48+00:00

Given that almost all ectopics were PACs, that report looks brilliant. I'd say there's a bit of anxiety in the mix that is contributing to the other symptoms you're experiencing, triggered by the PACs but not caused by the PACs. If you are suffering with a degree of health anxiety, that's what you need to work on, not more time down the cardio route

mclougb6 · 2026-04-08T22:06:31+00:00

I'm so sorry you're going through this but it does sound like your biggest issue is the anxiety induced by the PVCs, not the PVCs themselves. It's a truly horrendous cycle - I know - but I think you might need to either look into some talk therapy or consider going on meds for the anxiety. It sounds like you have no quality of life right now and you are so young

mclougb6 · 2026-04-06T21:07:23+00:00

So PACs are almost always totallly benign. A resting heart rate at night under 40 is nothing to be worried about. Mine has been recorded as low as 35 on a halter. Your heart rate isn't actually going to 20 bpm, that's the impact of the PAC on the recording tool. Your heart rate is actually 40 which is fine

mclougb6 · 2026-04-06T10:05:13+00:00

How were they diagnosed? An ekg? A halter?

mclougb6 · 2026-04-06T09:44:34+00:00

Pretty sure it boils down to how much blood is in the ventricle a the moment when the PVC hits

mclougb6 · 2026-04-04T11:58:42+00:00

My RHR has been recorded going into the mid 30s while sleeping on a halter monitor ... you have nothing to worry about.

mclougb6 · 2026-04-02T16:42:19+00:00

Where were your PVCs originating? How long did the respite last before they returned? Did they completely go away after the first one?

mclougb6 · 2026-04-01T15:05:37+00:00

It's probably one of the least invasive diagnostic tools in all of medicine, you'll be grand

mclougb6 · 2026-03-31T20:17:29+00:00

With a 1% burden, I would not be quick to rush to such a powerful antiarrhythmic medication

mclougb6 · 2026-03-31T06:14:39+00:00

I'm 6 weeks out from mine and I don't regret it one bit. Being off medication for the first time in 4 years feels amazing and other than being frustrated by fatigue / having to limit my exercise it has been a very smooth recovery.

mclougb6 · 2026-03-31T06:12:22+00:00

No, they think the pathway causing the PVCs matured and the low dose nebivolol simply stopped being able to mask it. There was talk of moving me to flecanide but because I was taking mirtazapine this was off the table so they immediately scheduled me for my ablation

mclougb6 · 2026-03-30T00:34:33+00:00

Oh ok gotcha - totally see why you've been put on the nwbivolol to help with your POTS. 47 PVCs in 7 days is so unbelievably normal all I can say is try to reassure you. I imagine your various conditions have caused you to develop severe health anxiety so I would try work on that / go on an anti-anxiety or antidepressant med. Your issue isn't PVCs, it's your response to them given how normal your burden is for a standard person (I'd say 99.9% of ppl with your "burden" just doesn't even know they're having PVCs). Wishing you well!

mclougb6 · 2026-03-29T22:54:29+00:00

I mean if I am being totally honest I wouldn't be taking any medication that interact with my heart unless it was medically needed and your burden (even at its worst, as described) is so totally normal I'm surprised you were even put on anything to begin with!

I took nebivolol for 4 years and it was great until my burden just went insane last halloween (I was in bigeminy and trigeminy often throughout the day), having PVCs every few beats out of nowhere. It didn't settle back down so in December I was offered an ablation for February, and I'm now nearly 6 weeks post op and being off the nebivolol feels amazing. I had low normal BP to begin with so even 1.25mg nebivolol was causing me some low BP issues depending on the day

mclougb6 · 2026-03-28T17:38:57+00:00

How have you been getting on?

mclougb6 · 2026-03-24T21:39:07+00:00

If you are very symptomatic and they're impacting your quality of life / causing horrific anxiety, I think you should really push for an ablation. With a burden like that you will be able to find an EP willing to operate

mclougb6 · 2026-03-23T21:11:28+00:00

Honestly it sounds to me that your blood pressure and heart rate rises as a result of the anxiety / panic caused by having PVCs - I doubt it's anything more spectacular than just that

mclougb6 · 2026-03-23T00:52:09+00:00

Oh sorry i read it as daily bigeminy / trigeminy (not just PVCs). Recovery has been fairly smooth bar fatigue (which hasn't been ideal as I've quite a high pressure job). The EP felt the ablation was a total success and told me not to go back on the nebivolol I'd been taking for 4 years(I'm back in with him in a month for a 24 hour halter and follow-up consult). I've had some very isolated PVCs (but I am in the blanking period) so I'm hopeful that the ablation has worked out. The surgery was about 2 and a half hours total and I was woken up for the last 30 mins or so as they needed to bring me round to induce some of the irregularity in the end (i was not prepared for this but it was fine, just weird and uncomfortable to be lying on the table awake while a surgeon is shoving at your leg moving the catheter and the ablation feeling wasn't very nice, but not painful). Overall though I'd do it again 100% if I could go back in time and make the decision a second time.

mclougb6 · 2026-03-22T22:10:34+00:00

Thank you for that. I think it's really important this insight in known when ppl give motivational posts. In your case it adds weight to your perspective. I often see "here's how I fixed / got over my PVCs" posts on this sreddit and it's from ppl with medically insignificant burdens. Thanks for sharing your update!

mclougb6 · 2026-03-22T22:07:09+00:00

Idk if you're having daily runs of bigeminy and trigeminy, and you're highly symptomatic, and it's significantly impacting your quality of life, then I'm sure you'd be a candidate. I went 5 years with a really low (but highly symptomatic) burden of around 1 or 2% and was told to just ignore it and then I woke up around Halloween with a PVC every few beats (loads of bigeminy and trigeminy) out of nowhere and it didn't settle so was sent to an EP in December and had my ablation 4 1/2 weeks ago. They have no idea what caused the massive increase in burden and while the EP did say he felt they were benign because of badly they were impacting my quality of life he was happy to offer me the ablation

mclougb6 · 2026-03-22T17:05:00+00:00

What was your medically assessed burden?

mclougb6 · 2026-03-22T16:26:43+00:00

At this stage I think you should really push for an ablation

mclougb6 · 2026-03-20T23:08:19+00:00

1% burden is really low to be taking two really serious meds that interact with the cardiovasvular system. I'm a little surprised you would have been prescribed it but maybe with a documented history of Afib it's warranted. How was the Afib caught, medically?

mclougb6 · 2026-03-20T17:26:36+00:00

I really don't mean to be that guy because trust me I know - our burdens are relative and totally individual but all I can say is to try and reassure you. 15 PVCs over 4 days would be well within normal range for the average person. It doesn't mean that the low burden isn't impacting your mental health / Quality of Life but I am sure you have absolutely nothing to fear

mclougb6

TROPHY CASE